Wednesday 25 February 2015

الغسان للسيارات تفتتح مركز خدمة متطور جديد لسيارات بنتلي ، لمبورغيني وماكلارين

الغسان للسيارات تفتتح مركز خدمة متطور جديد لسيارات بنتلي ، لمبورغيني وماكلارين
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Friday 18 October 2013

FSH treatment for patient where clomid is not working


FSH

FSH is the hormone which travels from the pituitary gland to the ovary, telling the ovary to grow and mature eggs each month. FSH is available in ampoules. Each ampoule has a dose of 75 or 150 units.
Treatment with FSH is the most powerful and reliable treatment for patients with ovulation disorders. Pregnancy rates of up to 15% per treatment cycle can be expected. The overall pregnancy rate for patients who need and use this treatment is in the order of 60% per patient. Unlike Clomid, the more serious the ovulation disturbance, the more likely FSH is to work.
The aim of giving FSH treatment is to mimic the normal egg development during the menstrual cycle. FSH injections are therefore given each morning as an intramuscular injection. It is best to start with the lowest dose of FSH per day (using 75 units per day). These doses are used for 4 to 6 days at a time. The ovarian response is determined by measuring oestrogen levels in the blood.
When the oestrogen begins to rise, the FSH is successfully growing an egg or eggs. If there is no response to a dose of FSH in 5-6 days of injections the dose will be increased. The normal dose increments are 75 units, 112 units, 150 units and 225 units per day. Most patients respond with 75 to 150 units per day. However it is very important that increments are only made cautiously. The ovary is very sensitive to FSH dosage and too much FSH rapidly grows multiple eggs. It is important that patients receiving FSH therapy start with the lowest possible dose and the increments in the dose are only made gradually after a trial of a particular dose for at least five to seven days.
When the blood levels of oestrogen rise to a point consistent with the mature egg an ultrasound scan will be done. The size and number of follicles (egg containing cysts) growing on the ovary can be measured. Follicle sizes of 14 to 20 mm usually indicate a mature egg. It is important to know the number of follicles present to minimise the risk of a multiple pregnancy.
If conditions are favourable, release of the egg is then initiated. The egg is released by giving an injection of hormone called Human Chorionic Gonadotrophin (HCG). HCG is a natural pregnancy hormone. It has a structure almost identical to LH and can therefore be used to trigger egg maturation and release. A dose of 2,000-5,000 units of HCG is given as an intramuscular injection. Egg release will occur 36 to 44 hours later. The HCG injection is therefore given 1½ to 2 days prior to intercourse or insemination.
HCG is also used to provide support to the ovary in the second half of the cycle after ovulation has occurred. As the first half of the cycle has been artificially created with FSH injections it is important to support the second half of the cycle. If this is not done there will be insufficient progesterone production and the pregnancy will find it very hard to implant as the corpus luteum undergoes premature degeneration. HCG injections 3 days and 7 days after ovulation will prevent this and provide appropriate early pregnancy support.
Side effects of FSH treatment are few. FSH is a natural hormone and apart from the inconvenience of a daily injection has little side effects. The major risks of FSH therapy are those of multiple pregnancy and overstimulation. Multiple pregnancy rates are up to 20% of all pregnancies produced by this treatment. If FSH treatment is not strictly controlled it is treatment with this ovulation drug which causes high order multiple pregnancies such as quins and sextuplets. The combination of oestrogen levels and ultrasound scan should be used to assess the likely number of eggs being released by the HCG injection. If more than two or three eggs are likely to be released, cancellation should be discussed with the patient.
It is very difficult in some patients, especially those with PCOS to choose the correct dose of FSH. If too little FSH dosage is used then no eggs grow. If the dose is increased only a very small amount sometimes many eggs grow on the ovary, often as many as 15 or 20. In some patients with PCOS there is no correct dose. Some patients with PCOS therefore have a very high risk of multiple pregnancy when FSH is used. Conversion to an IVF cycle is often used to control multiple pregnancy risk by only replacing one or two embryos. IVF pregnancy rates can be up to 40-50% per cycle depending on age.
If too much FSH is given the patient may develop over-stimulation syndrome. This is characterised by sore ovaries and a very swollen abdomen. It occurs about 7 to 10 days after ovulation and mostly in patients who are pregnant. It is actually very rare in patients who are having ovulation induction with FSH and then intercourse. Usually these patients do not have enough eggs growing to make overstimulation syndrome common. It is however much more common in patients who grow large numbers of eggs with FSH, usually on the IVF program.
The advantages of FSH treatment therefore include:
  • High pregnancy rates
  • Powerful management of serious ovulation disorders
  • Conversion to versions of the IVF program can occur with high pregnancy rates.
The disadvantages of FSH treatment are:
  • It carries a higher community expense although patients receiving this treatment have substantial government subsidies to make it quite affordable.
  • More sophisticated monitoring in the form of blood tests and ultrasound scans are required.
  • Multiple pregnancy rates are higher unless great care is taken.
  • It is a more inconvenient form of therapy as daily injections must be given.
    • New forms of FSH have the advantage of being able to be given by a smaller less painful subcutaneous injection. This is a small injection using a fine needle, which just goes under the surface of the skin into the fat rather than the deeper bigger injection into the muscle.

    Letrazole and Anastrazole

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    Wednesday 16 October 2013

    MEHFIL NAAT 2013 NOWSHERA VIRKAN 4 OF 8 (+playlist)


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    Thursday 26 September 2013

    Follicle or egg size classes showing size in different stages


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    Follicle development and their sizes


    Primordial Dormant, small, only one layer of flat granulosa cells Primordial follicles are about 0.03-0.05 mm in diameter.

    Primary Mitotic cells, cuboidal granulosa cells Almost 0.1 mm in diameter Secondary Presence of theca cells, multiple layers of granulosa cells The follicle is now 0.2 mm in diameter


    Early tertiary The early tertiary follicle is arbitrarily divided into five classes. Class 1 follicles are 0.2 mm in diameter, class 2 about 0.4 mm, class 3 about 0.9 mm, class 4 about 2 mm, and class 5 about 5 mm.

    Late tertiary Fully formed antrum, no further cytodifferentiation, no novel progress Class 6 follicles are about 10 mm in diameter, class 7 about 16 mm, and class 8 about 20 mm. It is common for non-dominant follicles to grow beyond class 5, but rarely is there more than one class 8 follicle.

    Preovulatory Building growth in estrogen concentration, all other follicles atretic or dead
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    Wednesday 18 September 2013

    Follic scan when on clomid treatment in case of infertility


    Follicle Tracking | Follicle Scanning
    If you are a woman trying to conceive, one of your biggest challenges in fertility as you grow older is the suitability of your eggs. Egg production can be greatly affected by your age both in quality and in number. By the time you are in your late 30s or early 40s, you will probably have more poor quality eggs available than good quality eggs. The impact of poor quality eggs is reflected in the general decline of pregnancy rates as women age.
    One of the first steps a woman should take when making the decision to conceive is to have Follicle (Follicular) Tracking carried out by a doctor or a qualified sonographer. This will help to identify two things; whether or not she is ovulating and, if she is, the scan will additionally pinpoint the exact time when the follicle ruptures and releases the egg. This information enables a couple to time intercourse in order to maximise their chances of conception.
    What is Follicle Tracking? Follicle Tracking involves a series of vaginal ultrasound scans, starting from day 9 to day 20 of your cycle. These scans allow you to observe the follicle(s) developing in your ovary. The scans are performed using a small plastic probe which is inserted in the vagina. The process is relatively painless.
    The Process of Follicle Tracking Initially, a base line scan is carried out to determine the overall health of the reproductive area and to check for any issues that may impede conception such as fibroids, polycystic ovarian syndrome or ovarian cysts.
    During a normal cycle the egg develops within a follicle in the ovary. This follicle is a thin walled structure containing fluid along with the egg attached to its inner membrane. The follicle appears as a circular fluid-filled bubble on the screen and can be seen when it is about 7-8 mm in size. It grows at a rate of about 1-2 mm per day and is ready for ovulation when it measures within the correct range of 17-25 mm in diameter. During the tracking process, the number of developing follicles and their size are measured and charted as well as ovulation being noted if and when it occurs.
    In conjunction with assessment of the follicles, the development of the lining of the womb is also recorded during Follicle Tracking. In order for a pregnancy to occur, the uterine lining must be receptive to a fertilised egg in order for the embryo to implant successfully. The Follicle Tracking process measures the appearance, development and thickness of the lining of the womb as the cycle progresses.
    How do I know Ovulation has occurred? Following ovulation, the follicle usually disappears from the scan picture completely or the walls of the follicle become irregular and collapsed. This is the best evidence that ovulation has occurred. Fluid can often be simultaneously detected in the abdomen behind the uterus. This is the follicular fluid that is released when the follicle ruptures.
    What else can Follicle Tracking detect? As well as general issues that may impede pregnancy, which will be identified during the base line scan, there are other problems that Follicle Tracking can detect, including:
    Follicles which do not grow to the correct size before rupturing Follicles which do not grow at all Follicles which do not rupture at the appropriate time The lining of the womb may not have thickened sufficiently to enable implantation of a fertilised egg. Each of these aspects can be identified using Follicle Tracking, which gives you a much clearer view of what is happening, when it is happening and what, if anything, is going wrong.
    How many scans per cycle will I need? Usually in each cycle there will be between 4 and 6 scans, but this depends on the cycle. You can ovulate any time from day 6 to day 26 of your cycle and the base line scan will help to determine the initial size of the dominant follicle. Following a consultation between you, the sonographer and Karen, the timing of the next scan will be ascertained. As the cycle progresses, a very clear picture will develop of how the follicle is growing and if the lining of the womb is developing in conjunction with the follicle.
    How long does the scan take? Follicle Tracking takes between 5 and 10 minutes to perform. You will receive a written report which will help determine the required acupuncture treatment.
    Who should have Follicle Tracking? There are four main reasons to choose Follicle Tracking:
    If you don’t know when you are ovulating – ovulation can occur from day 6 to day 26 and while ovulation predictor sticks can work accurately for some women, they can also be up to 5 days out. If you are not sure you are ovulating at all – this can be very hard to detect without scanning as periods may seem normal. If you have had several early miscarriages – Follicle Tracking will be able to assess the womb lining, ensuring it is in the appropriate state to enable implantation to occur. If you are on Clomid – this drug is used to induce ovulation, to correct irregular ovulation, to increase egg production and to correct a condition known as luteal phase deficiency, where the lining of the womb does not sustain the pregnancy. Many doctors recommend that women on Clomid are monitored to ensure the ovaries and the lining are both responding normally. How 5 Element Acupuncture helps Any issues, which are detected during the Follicle Tracking process, can be treated with 5 Element acupuncture.
    This includes issues that may arise following the base line scan:
    Fibroids Polycystic ovarian syndrome Ovarian cysts Endometriosis. In addition, 5 Element Acupuncture can also help in other ways, including: Increase the speed of growth for any follicles Enhance the preparation of the lining of the womb Increase the likelihood of implantation by decreasing stress hormones in the body. Increase progesterone levels in order to sustain the pregnancy after the embryo has implanted How much does Follicle Tracking cost? There are many practitioners offering Follicle Tracking throughout the country of Ireland. Karen’s practice has researched the various clinics offering this service and can make recommendations accordingly. She will discuss such options during your initial consultation. Prices range from €120 for 6 scans to €270 for 3 scans, depending on the clinic you choose. All Karen’s acupuncture clients can avail of special discounts for Follicle Tracking.
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    Tuesday 27 August 2013

    MEHFIL NAAT 2013 NOWSHERA VIRKAN 2 of 8


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